House of Delegates
CAP House of Delegates –
Health Care Reform and the Transformed Pathologists
The CAP House
of Delegates held its Fall meeting on Saturday, October 10,
2009, in Washington, DC. The meeting focused on health care
reform and the transformed pathologist.
The House
began its meeting with presentations by College leaders
focusing on the transformation of pathology. Outgoing CAP
President Jared N. Schwartz, MD, PhD, FCAP told the House
that the Transformation is in motion and some of the
initiatives the College has undertaken are becoming a
reality, particularly the Institute and the Center. He told
House members that pathologists must find a way to insert
themselves into the lives of their patients and work with
the patients and their families to demonstrate value and he
encouraged delegates to keep their office doors open, not to
make sure people can come in, but to ensure that they (the
pathologists ) can go out. Dr. Schwartz thanked the House
for their participation during his presidency and encouraged
them to keep up with their revitalization.
Charles
Roussel, Executive Vice President of the College, told the
House that the College is staying ahead of the crowd in
order to secure the future of the specialty and that the CAP
is investing in the Transformation and working to increase
revenue growth in order to fund it. Mr. Roussel informed
delegates that the College is looking into ways to improve
the image of the pathologist and expanding into
international markets. Finally, Mr. Roussel encouraged the
delegates to start thinking, and start saying, that “If the
diagnosis is wrong, nothing else matters.”
Thomas
Malone, the College’s new Vice President of Transformation,
updated the House on the progress of the CAP Pathology and
Laboratory Quality Center (The Center). The Center will be
responsible to develop evidence- and consensus-based
guidelines focused on patient care. It officially launched
at CAP’09. Through its work, the Center will demonstrate the
central role of pathologists in the patient care team, serve
as a “brand” to promote guidelines from across the College,
and drive additional value for the College by helping to
mitigate the risk of government involvement, enabling the
creation of pathology-specific performance measures,
creating rigorous quality standards for AP, and facilitating
alliances with other medical specialties and patient
advocacy organizations. Mr. Malone told the House that the
College needs their help with the Center. Members can submit
topics for Center guideline development at
www.cap.org/Center
or volunteer to “champion” a proposed Center topic and lead
a Center Workgroup, or participate in workgroups.
In order to
showcase a transformative technology, the House heard a
presentation on Endoscopic Microscopy: Bridging the
Radiology/Pathology Divide by Guillermo J. Tearney, MD, PhD.
Dr. Tearney demonstrated a current technology that provides
a microscopic view of issue inside the patient and told the
House that the technology is on the way that will replace
the need for glass slides.
After a
lunchtime presentation on health care reform by Former
Senator Tom Daschle (D-South Dakota), the House heard a
presentation from John Scott, Vice President of Advocacy, on
the Now and Future Advocacy Agenda of the College.
The College’s
Pathology Now Agenda includes physician payment and the
sustainable growth rate; Medicare physicians advisory
committee and independent Medicare advisory council; linking
patient outcomes to payment; health information technology;
self-referral and transparency; and comparative
effectiveness research. The College’s Pathology Future
Agenda is centered on the pathologists’ potential future
role in a coordinated care model.
Through its
advocacy efforts, the College has made some progress on the
Now Agenda. It appears SGR will be corrected, at least in
short term. Mr. Scott stated that it is important to note
that the Senate bill, which is the only on the Congressional
Budget Office says balances, does not permanently fix the
SGR. Primary care bonuses will likely be granted and this
potentially could impact pathology payments. Penalties for
non-participation in pay for performance are still possible
in 2012, creating risk for our members and action on
self-referral will be limited. The College does expect the
Technical Component Grandfather to be extended and that some
revaluation of our anatomic pathology codes will have to be
undertaken.
The College’s
plan for the future role and agenda for pathologists is that
pathologists provide direct patient care through diagnostic
test selection, performance, interpretation, and direction
on optimal therapy options to patients and to clinicians. In
order to make this a reality, policy changes will need to
obtained to provide new payment for consults initiated by
pathologists for appropriate test selection and therapy
management and full access to the patient’s Electronic
Health Record. The College’s Transformation Ask is for
Medicare payment policy to be modified to pay for diagnostic
consultations initiated by pathologists with clinicians and
patients on test selection and therapy management and that a
demonstration project should be conducted to evaluate the
role of the pathologist as test selector and therapy manager
in terms of reduced costs and improved care. Mr. Scott told
that House that we are in the beginning phases of this
campaign and the initiative and our work is just starting.
Policy makers and other stakeholders are just learning of
our proposal for the future and they are receptive to the
role we envision, but we will need to better define the
services, cost savings and benefits to patients as well as
how to measure it.
House members
then had the opportunity to discuss health care reform as it
pertains to pathology. Overall, House members were concerned
with:
-
self-referral issues;
-
unintended consequences of the bills;
-
competition from other specialties for the consultant
role;
- being on
the sideline as part of the health care team rather than
centrally located to patient care;
- lack of
attention to Tort reform, and;
- no
permanent fix for the SGR.
In addition,
house members felt that the highest priority for the College
should be a permanent SGR fix, AP CPT revaluation by RUC,
documenting the role and value of the pathologist, and
coordination with other clinical societies. Finally, House
members saw access to patient information and integration of
health information across the country and payment issues as
challenges and opportunities to the new, enhanced role of
the pathologist.
In addition
to health care reform and the transformed pathologist, the
House held discussion on four topics of importance to the
College and the specialty.
Amendments
to the CAP Bylaws
The House discussed and endorsed two proposed amendments to
the CAP Bylaws. These amendments are to ARTICLE VIII.
Miscellaneous Provisions; Section 2. Professional Relations
and ARTICLE VI. Discipline; Section 2. Disciplinary
Procedure. The amendments adjust the language to state that
members are governed by the CAP Principles of Ethical and
Professional Conduct and change the procedures for
disciplinary action against a member from a bylaw to a
policy, thus allowing the College to respond more quickly to
allegations of unprofessional behavior of a member. These
amendments will be presented to the College membership for
approval and will carry the endorsement of the House.
Custodianship of Human Biospecimens and Their Derived
Products
The House discussed the CAP Policy on Custodianship of Human
Biospecimens and Their Derived Products and its consequences
to pathologists. The House agreed that there was a need for
setting standards on this topic, not limited to standards on
storage, fixatives, and technology. Information from the
House regarding this discussion will be sent to the CAP
Center as a suggested topic for a standard.
Lymph
nodes to be identified in any colon resection for carcinoma
Dr. John Harbour, Virginia Delegate, presented a discussion
item to the House on the concept of the minimum number of
lymph nodes. The House agreed that the current “minimum”
number of 12 has no reference to validity and that the goal
should be to “maximize the number of nodes you harvest”.
Information from the House regarding this discussion will be
sent to the CAP Center as a suggested topic for a standard.
The
Transformation of the Practice of Forensic Pathology
Dr. Kim Collins, South Carolina Delegate, presented to the
House on the need for Transformation of the Practice of
Forensic Pathology and the death investigation system. She
told the House that a recent NAS (National Academies of
Sciences) Report recommends: 1) Forensic autopsies should be
performed or supervised by forensic pathologists; 2)
Pathologists testifying in court on the findings of a
forensic case should be certified; 3) Steps should be taken
to replace coroner systems with medical examiner systems.
The House agreed that the coroner system is outdated and a
change is necessary and generally supported the 3 NAS
recommendations. Delegates agreed to ask the College of
American Pathologists to support the recommendations of the
National Academies of Sciences and the National Research
Council and be a participant in the transformation of the
current practice of forensic pathology in medicolegal death
investigations, to collaborate with other pathology
associations such as the National Association of Medical
Examiners to protect the practice of its members while also
serving the public by optimizing the practice of forensic
pathology, and to take a lead position in transforming the
current antiquated death investigation system and practice
of forensic pathology and work with other professional
organizations to update the 1954 Model Post Mortem
Examinations.
Submitted by,
Louis Zinterhofer MD
Chair, NJ CAP House of Delegates
CAP House of Delegates
Agrees to PathPAC Contribution Initiative
The CAP House
of Delegates held its spring meeting on March 7, 2009 in
Boston, Massachusetts. With 78 delegates representing 33
delegations in attendance, the Spring 2009 meeting was the
largest Spring Meeting in recent House of Delegates history.
The delegates held interactive discussions with the CAP
leadership team about the Strategic Directions of the
College, new practice model concepts, representation of the
International Fellow Class in the House of Delegates, and
support for PathPAC. In addition, the delegates heard
presentations by the candidates who have declared for the
office of President-Elect in the 2009 election, the
College’s Strategic Plan, and the College’s Leadership
Platform from the new Executive Vice President.
Stephen N.
Bauer, MD, FCAP, CAP President-Elect, outlined the CAP
Strategic Plan and the Transformation Platform, and updated
the House on some recent College activities. Dr. Bauer told
the House that that the pathologist needs to have a direct,
active, and more visible role in patient care. He told the
House that the College must now translate the Vision into
action and be the driver of the transformation. He then
outlined the high level strategic directions of the College:
- Promote
quality in the practice of Pathology.
- Lead the
provision of life-long learning opportunities that will
prepare pathologists for the future and to assume new
roles in the evolving healthcare landscape.
- Improve
laboratory quality and patient safety through expansion
of CAP quality improvement programs.
- Expand
the membership and strengthen support of their
professional needs.
- Advocate
for public and private policies in the best interest of
Pathology, patients and healthcare.
- Exercise
leadership in Health Information Technology advancement
that enables Pathology to make the maximum contribution
to high quality, cost effective healthcare.
- Maintain
fiscal integrity, effectiveness and agility in
proactively pursuing its role as driver of the
transformation of Pathology.
Dr. Bauer
told the House that, with the work of EVP Charles Roussel,
these directions are being repackaged into tangible,
measurable strategies that will complement the work of the
Strategic Planning Committee. He also told the House that
the teams working on the development of the Center and
Institute are working to address the concerns and
incorporate the ideas expressed by the House at the Fall
2008 meeting.
Speaker of
the House Thomas Joseph Cooper, Jr, MD, FCAP, introduced the
House to the new CAP Executive Vice President, Charles
Roussel. Mr. Roussel was most recently a director of the
Atlantic Philanthropies, where he worked to bring healthcare
back into schools and advocated for greater funding for
preventive medical and mental health services. He previously
served as a Managing Partner at Accenture, where he helped
clients around the world envision and effect
transformational change. Mr. Roussel told the House that the
College will not be able to secure a better future without
active grassroots support. He explained that time is of the
essence; other specialties are staking a claim to the
traditional pathologist role, creating a risk that
pathologists will be marginalized as technicians. Mr.
Roussel told the House that he has been hired to lead the
College in its efforts to transform the practice of
pathology and the role of the pathologist, and to unify
staff and the Board in the pursuit of a common change
agenda. The internal transformation of the College will be
known as the PATH Forward. The platform consists of three
leadership themes - market focus, operational discipline,
and catalyzing the transformation. Mr. Roussel reiterated
that the transformation of the specialty and the College is
a generational undertaking and that the College is fully
committed to this endeavor.
In the spring
of 2008, the House of Delegates endorsed the establishment
of an International Fellow membership class for the College.
This class was approved by the Fellows of the College in the
summer of 2008 and is available to pathologists practicing
outside of the US and Canada. At the Spring 2009 meeting,
the House discussed the possibility of extending membership
in the House to members of the International Fellow Class (IFCAP).
It was decided that IFCAP members may attend the House
meetings and participate in the discussions, but will not be
allowed to vote at the House meeting. In addition, the
Speaker of the House will make the decision to seat IFCAP
members on an individual basis versus a delegation being
established.
During the
summer of 2009, the College will be holding elections for a
new President-Elect. In order to inform the House of each
candidate’s platform, the three declared candidates for the
office gave brief presentations on their history and vision
for the future. Following the presentations, House members
asked questions of the three candidates. In addition, Dr.
Cooper told the House that they may be asked to play a
pivotal role in this year’s election. He explained that,
according to the CAP Bylaws, in the event no candidate
achieves a majority the House of Delegates will elect the
next President-Elect by secret ballot at the Fall Meeting.
During a
reference committee of the whole, the House discussed some
possible new practice models and the issues surrounding
them. The House agreed that members need help to better
understand the issues surrounding new practice models and
mergers, and how to join together in mutually beneficial
ways. It was noted that discussion surrounding new practice
models is a cornerstone of the Leadership Platform. It was
agreed that a report outlining the House discussion will be
provided to the necessary parties for input.
Finally, the
House discussed how it could help increase pathologist
support to PathPAC. PathPAC Chair, Richard A. Bernert, MD,
FCAP told the House that while contributions to PathPAC have
been increasing, there is still more that needs to be done.
In order to have a seat at the Healthcare Reform Table, more
members need to contribute. The House of Delegates affirmed
its commitment to PathPAC, pledging to increase
participation among Delegates from 50% to 100% by the next
meeting in October. House members agreed to renew their
PathPAC contribution in 2009, make their contribution
habitual, and consider contributing the value of a single
88305 each month to the PAC (PC: $38 x 12 = $456 or Global:
$104 x = $1,248). They also agreed to spread the word to
other members and recruit 5 colleagues to contribute.
PathPAC now has the capability to automatically deduct a
monthly contribution on your credit card. If you would like
to sign up for this program, or have any other questions
about PathPAC, please contact Susan Askew in CAP Washington,
DC office at 202-354-7105.
The House now
looks forward to CAP’09 at which they will continue to
discuss issues of importance to the College, its members,
and the practice of pathology. The Fall 2009 meeting is
scheduled for Saturday, October 10 in Washington DC. There
will be a House of Delegates dinner on Friday evening and
the inaugural gala for Stephen N. Bauer, MD, FCAP on
Saturday evening. Delegates will receive information on the
upcoming meeting and events in the coming months.
For more
information on the CAP House of Delegates, contact Shannon
Peterson at ext. 7393 or
speters@cap.org.
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